Revised guidelines for initiating ART - WHO (comparision of 2006 & 2009 guidelines)

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Dear all

The following table

depicts the revised

WHO guidelines on ART ( adults and pregnant mothers)

released on 30th Nov 2009.

2006 WHO guidelines

2009 WHO guidelines

Benefits

Initiation

of ART

(adult

male & non pregnant female)

ART

can be started for all patients with advanced clinical disease and/or a CD4

count of 200 cells/mm3 or less.

(In India:

it was 200 cells/mm3. but revised to 250cells/ mm3- in 2009)

ART can be started when the CD4 count falls to 350

cells/mm3 or less, regardless of symptoms.

An earlier starting of treatment reduces a

person’s viral load much earlier in the course of their HIV infection,

and so reduces the risk of onward HIV transmission and could potentially

avert a significant number of new HIV

infections. Earlier treatment would boost the immune system, making it less

likely that the patient falls sick with TB and other opportunistic diseases.

This would benefit both the individual concerned and help protect the wider

community against the risk of infectious TB.

ART

regimen

(adult

male & non pregnant female)

Use

of  ART - Stavudine containing regimens was encouraged due to its low cost,

limited need for laboratory monitoring, initial tolerability and widespread

availability.

(In India

- widely used)

It has been recommended to phase out the use of Stavudine

as a preferred first-line therapy option and move to less toxic ART such as

Zidovudine and Tenofovir

The phasing out of Stavudine would enable new and existing

patients to avoid disabling and disfiguring side effects (fat redistribution)

and reduce the costs of managing these toxicities.

Initiation of ART

for Pregnant mothers

ART

can be started for pregnant mothers with advanced clinical disease and/or a

CD4 count of 200 cells/mm3 or less.

(In India:

it was 200 cells/mm3. but revised to 250 cells/ mm3- in 2009)

ART can be started for pregnant mothers when the CD4 count

falls to 350 cells/mm3 or less, regardless of symptoms.

Clinical trials have proven that initiating ART at CD4

count less than

350 could prevent 75% of transmission of HIV from mother to child.

ART during breast feeding

Not recommended world wide

If

on Zidovudine based regimen during pregnancy

Mother:

Continue same drugs for mother

Infant: Daily Nevirapine

till

end of Breast feeding period

The new regimen has the great potential to improve the

mother's health

and also to reduce the mother to Child HIV transmission from 35% to 5%.

The new recommendations would virtually eliminate pediatric HIV

ART prophylaxis for

 pregnant mothers

ARV

prophylaxis from 28th week (7th month).

Recommended regimen -Daily Zidovudine & Single dose Nevirapine.

For Infant - prophylaxis for one week

( In India

, it is only single dose Nevirapine tablet for mother & single dose

Nevirapine drops for infant)

ARV prophylaxis from 14th week (4th month).

Mother -Daily Zidovudine .

Infant - prophylaxis for six week

or

Three

drug regimen through out the pregnancy & breast feeding period and infant

prophylaxis for six weeks

Pls note this is the

revised guidelines by WHO and not representing that of NACO

Dr.P.Mahalingam

Senior Program Manager (Care & Treatment),

AIDS Prevention And Control (APAC) Project,VHS,

Adyar,

Chennai -600113.

Ph: 044 22541048

web:www.apacvhs.org

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